Provider Demographics
NPI:1760732093
Name:JACKSON, SHAARON D (MA-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHAARON
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 4TH STREET NE
Mailing Address - Street 2:AUBURN SCHOOL DISTRICT
Mailing Address - City:AUBURN, WA
Mailing Address - State:WA
Mailing Address - Zip Code:98002
Mailing Address - Country:US
Mailing Address - Phone:253-931-4927
Mailing Address - Fax:
Practice Address - Street 1:915 4TH STREET NE
Practice Address - Street 2:AUBURN SCHOOL DISTRICT
Practice Address - City:AUBURN, WA
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-931-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA01107304OtherASHA